Whew! 15 Minutes Is A Long Time!

Being the subject in a feature article which appeared in the first section of the Sunday edition of a US major newspaper like the Chicago Tribune was wholly a great experience, but also one in which I am relieved is diminishing in attention.  Like a child standing abreast the Sundae Buffet Bar at a local eatery piling one bizarre topping atop the last, the news cycle here in Chicago has a short attention span, especially when the subject (me) is an unknown (me).

It was the condition (bipolar); its manifestations before diagnosis; the odd behaviors preceding a mental breakdown; the swath of tawdry details, hateful accusations, and trust-damaging honesty laid bare which piqued their interest. The reporter who, with an eye focused on sensitivity, remained intent to anatomize sequential events like they were the identifiable behavioral ingredients required to produce a blue-ribbon breakdown pie.  She often returned to the timeline which, like a mooring buoy, guides a diver safely to the wreck.  However, my timeline represented a fall from grace, a clawing desperation numbed by opiates, acts of treason undermining my relationships; and finally, any semblance of sanity or allegiance to life was pitched like an unwanted circular.  The drilling for details only struck bedrock when trivial yet salacious activities, freely offered as context, had to be included in the article to highlight the stakes of my all in bet.

Absolutely not!  I would not be drawn-and-quartered on page 8, section 1, the entrails of my privacy displayed like human anomalies hawked at second-class side-shows!

I made it very clear: I’m not ashamed nor am I proud of my behavior, the pain it caused others, my professional devastation, the annihilation of trust, or the surrender of an identity.  But there’s a difference between honesty and privacy when it involves my life and the lives of those dearest to me.  I have been candid and explicit and straightforward.  But if your newspaper can’t respect what I say is private, then they must not respect what I’ve determined to be public.  In which case they can’t have any of it!

And that stand on my own behalf was my take-away.  Before 2008 I always felt like I had too keep going, had to get promoted, had to make six figures, because there was always somewhere to go, a place just beyond my reach that would be better, easier, calmer.  And on I went, like so many of my friends, pursuing. . .something. . .

After 2008 that place which had been so important to get to disappeared along with the constant gnawing I heard, and the “coveted by others” baubles bought to fill an expanding void where truth-to-self and character once resided, and year after year after year of acrimonious evaluations designed to hobble my self-worth.

I find great joy and comfort and silence knowing there really is nowhere else than right where I am.

 

Chicago Tribune Feature – Published Sun., Aug. 26

No rhetoric; no sublime style; no lexicons or etymology.  Pure and simple disclosure of disquieting issues.

Please, REPOST THIS ON YOUR BLOG.  Personally, I prefer privacy over publicity; I exposed my life in the hope that the stigmas of mental illness, obesity, and homosexuality might be reconsidered to be human conditions worthy of respect and empathy.

http://www.chicagotribune.com/health/ct-met-bipolar-20120824,0,3948031.story

Bipolar II disorder: Another Chicagoan’s story

Like Jesse Jackson Jr., Harlan Didrickson has the illness and has had weight-loss surgery

 Harlan Didrickson poses outside his Rogers Park home. (Chris Walker, Tribune photo / August 17, 2012)
By Barbara Brotman, Chicago Tribune reporter, August 26, 2012
Harlan Didrickson was a model of middle-class stability.He lived with his partner of more than two decades in a handsome Victorian on a leafy North Side street. He worked as manager of executive and administrative services for a high-powered architectural firm, where he made hospitality and travel arrangements for large meetings and oversaw budgets that ran into millions of dollars.He was not the kind of person who would go to lunch with friends and come home having spent $4,500 on a puppy and a month of obedience training.

Or who would get up at 2 a.m., go to Dunkin’ Donuts, then drive to Indiana and back, snacking on Munchkins.

But that’s who he became.

Four years ago, his life was upended by bipolar II disorder, the same illness recently diagnosed in U.S. Rep. Jesse Jackson Jr.

This is not Jackson’s story. People with the disorder — nearly 6 million in the U.S. — have unique experiences with the illness, which cycles between moods of manic energy and deep depression.

“The symptoms of bipolar disorder can be very different from one person compared to another,” said Dr. John Zajecka, a psychiatrist with Rush University Medical Center who specializes in mood disorders.

Manic states leave some people euphoric, others irritable. “There are people who can function their whole lives in these hypomanic states,” though they may lose marriages, jobs and money, Zajecka said.

Depression, too, can appear in a variety of ways. Some sufferers stay in either mania or depression for decades; others cycle between them many times a day. And people respond differently to treatment.

But Didrickson’s struggle provides one look at how bipolar II disorder and its treatment can affect a life.

And he does have one key factor in common with Jackson. Like the congressman, Didrickson, 54, had weight-loss surgery before being diagnosed with bipolar. He had a gastric bypass procedure; Jackson had a duodenal switch.

It became a serious complication in his treatment. The weight-loss procedure, which causes the body to absorb fewer calories, prevented him from absorbing the full dose of his antidepressant medication.

Didrickson’s illness began when he started feeling extremely stressed at work. He considered himself skilled at his job but felt beleaguered by office politics.

“I felt as though I was fighting a lot of fights on different fronts in my life, and that I didn’t have the wherewithal, the energy,” he said. “I was profoundly unhappy.”

He changed jobs, twice. He still felt miserable. And he also felt trapped, having to do work he now found unbearably stressful.

More than 60 percent of people with bipolar engage in substance abuse as they try to self-medicate their inner pain. Didrickson was among them. At night he would wash down some hydrocodone, an opiate he had been prescribed for a back injury, with beer. He would stay up till 4 a.m. watching TV, then take Ambien to fall asleep.

“At 6 o’clock I woke up, got dressed and went to work. I was probably still high,” he said. “Then somewhere around noon, I would crash. I would go to the men’s bathroom, go sit on the toilet and fall asleep.”

His partner, Nick Harkin, a publicist with an entertainment and lifestyle marketing firm, had no idea how deeply troubled Didrickson had become.

But then Didrickson didn’t show up on time for a planned out-of-town getaway. When he arrived the next day, he was morose, secretive and exhausted. “It was a very abrupt shift,” Harkin said. “It was quite obvious that something was very seriously wrong.”

Didrickson was thinking of ending their relationship, he told Harkin. And he wanted to move to California’s Death Valley. He wanted to start a new life.

“I was falling apart,” Didrickson said. “It was this desperate: I will do anything to get out from under this pressure.’ It was like having a heart attack, and if you don’t get out from under it, it will kill you.”

Back home, he called a friend who had once been his therapist. She asked if he was suicidal.

“I was, like, ‘Of course I am. I think about it all the time,'” he said. “‘It’s the only comfort I have.'”

She told him to see a psychiatrist. He did, and was told he had depression — a common initial diagnosis for people with bipolar, who generally seek treatment during a depressed phase of the illness.

The antidepressant the doctor prescribed didn’t work. Didrickson developed memory problems, to the point where he forgot how to do simple tasks like using a phone.

“I could not take a shower, because I couldn’t recall the sequence of activities … turning on the water, stepping into the spray, getting wet, washing,” he said.

He lost 40 pounds and neglected bathing and grooming. And yet there were also times when Didrickson felt powerful, energetic, nearly like a superhero. He could do anything he wanted, no matter how dangerous or destructive, with no consequences.

He ran red lights. He drove the wrong way down one-way streets. “I felt like I was back to being in charge, like I was back to saying, ‘It’s going to go like this because I said so,'” Didrickson said. “I felt kind of emancipated.

“I thought, Wow, this (antidepressant) Paxil is really working.'”

But it wasn’t. A psychopharmacologist gave him a new diagnosis: bipolar II disorder, a form of bipolar disorder with less extreme mood swings.

His new doctor told him to stop self-medicating — Didrickson said he hasn’t had a drink or abused a drug since — and put him on a mood stabilizer. And then began the painstaking process of trying to find the right antidepressant: six weeks getting to a therapeutic amount of a drug, then six weeks being weaned off when it didn’t work, again and again.

“My symptoms came back. I just felt terrible,” he said.

He was still manic, once getting up at 4 a.m. to drive to Lake Shore Drive to look at newly fixed potholes. He spent money recklessly. He spent hours obsessing over the paper stock to use for custom stationery.

The manic states always turned dark, ending with him lashing out at people — usually Harkin.

“When I begin my mania, it’s a great party,” he said. “But when it gets to be months into it, it gets uglier and uglier and uglier, to the point where you really are a monster.

“Mania isn’t happy; mania is crazy,” he said.

No antidepressant worked. Then a friend with bipolar recommended Adderall, the stimulant often prescribed for attention deficit disorder.

His doctor prescribed a standard amount. It did nothing.

So Didrickson took another dose. And he felt a little better.

“I started to feel buoyant,” he said. “I always talk about feeling underwater. I felt like I was finally breaking the surface.”

He didn’t know why he needed a higher dose. But then he came upon online message board postings by people who had undergone gastric bypass surgery and then found that their antidepressant medicines stopped working.

The gastric bypass surgery he had undergone years earlier to lose weight, he concluded, was keeping his body from absorbing the medicine.

Indeed, Zajecka said, gastric bypass surgery can change how people absorb medicines given for bipolar disorder.

The Mayo Clinic statement announcing Jackson’s diagnosis also noted that the weight-loss surgery he had “can change how the body absorbs food, liquids, vitamins, nutrients and medications.”

Didrickson’s doctor would only marginally increase his dosage of the notoriously abused amphetamine. It wasn’t until he switched doctors because of a change in his health care coverage that he got what he found to be an effective dose.

His longtime internist, Dr. Eric Christoff, assistant professor of clinical medicine at Northwestern University’s Feinberg School of Medicine, gradually increased Didrickson’s dosage, with weekly appointments to check his blood pressure.

The depression lifted. He has been on the higher dosage for a year and a half.

“We have never seen any evidence of drug toxicity or high blood pressure,” Christoff said. “He’s really not absorbing much of any dose he’s taking.”

Many people with bipolar disorder are able to resume their previous lives.

“It’s one of the most treatable illnesses we have in medicine,” Zajecka said. “If it’s diagnosed properly and treated appropriately, there’s no reason they can’t get back to resuming a normal lifestyle and their normal goals in life.”

But Didrickson has been unable to go back to work and still has periods of depression and mania, though much milder ones. He manages the house, cooks and has taken up woodworking.

“Going out in the evening can be very, very, challenging for him,” Harkin said. “If we go to a concert or a dance performance and it’s too noisy, he’ll have to leave. If … there’s someone in a film who’s violent or cruel, that’s very upsetting to him too.”

“It’s nothing like I thought my life would be,” Didrickson said.

“The good thing, I guess, is that I don’t hold on to yesterdays,” he said. “That’s a blessing, I think, frankly. But I also don’t have tomorrow. My life isn’t about tomorrow.”

He has gone back to writing, which he did in college. He writes a blog about his experiences with bipolar, under the name T.M. Mulligan. The moniker stands for “Taking My Mulligan.”

“I’m having my do-over,” he said. “I’m taking the second chance.”

Copyright © 2012, Chicago Tribune

Chicago Tribune Feature – Set to Appear This Week

Early last week I was contacted by a staff reporter from the Chicago Tribune newspaper asking if I’d be willing to share Life With Bipolar II.

I’m a private person by nature, but also an author rummaging through his past looking for experiences which, when written in my style will leap from me and land on you resulting in some degree of change expressed through your thought or action.  I don’t write for the sake of writing.  I write with purpose; with hope that my style captures your attention; and with honesty so that a kinship occurs as you read and when finished actually feel something whether it be acknowledgement, empathy, entertained, or moved.  If you don’t experience any shift then I have failed you as a writer.

So many people know so little about mental illness generally, and Bipolar specifically, that to decline the opportunity to be featured in a full-page story in one of the top five newspapers in the country (not too mention their on-line edition) would be foolhardy.  There’s no possible way that I and this blog occupying a little corner of the internet could reach the number of readers that this article will touch.

I have spent ten hours on telephone interviews; two hours of photography here at my home; my partner’s been interviewed, and so has my physician.  The process has been, frankly, unnerving and profoundly confronting and nowhere near as safe as if I’d been writing it.  But I agreed because too many American’s need to understand that mental illness is a disease.  Doctor’s need to understand that a post-gastric by-pass patient won’t respond to medications as expected.  Patients living with mental illness need to believe that sharing themselves with others is the only way to dilute discrimination based on mental health.

Please watch for it!

Bipolar Diagnosis Is Not An Insanity Defense

I’ve been paging through comments left recently at Chicago news sites regarding the recent revelation that Representative Jesse Jackson Jr. (Congressman, Illinois) has been diagnosed with Bipolar II and is currently experiencing a major depressive episode and is being treated at the Mayo Clinic.  He’s been on a leave-of-absence since June when he was discovered by his father, Rev. Jesse Jackson, exhausted at Rep. Jackson’s Washington, DC home.  The family took Rep. Jackson to Sierra Tucson Treatment Center in Arizona, then moved him to the Mayo clinic where he remains, undergoing treatments for his significant depression.

If the picture I just painted was about your husband or wife, your child, a relative or neighbor, teammate, fellow parishioner, acquaintance, sister-to-the-father-of-your-daughter’s-fiance’s-birth-parents, or celebrity, your reaction, most likely, would contain differing degrees of empathy based in part on your knowledge of mental illness, specifically Bipolar II.  But what if the picture I just painted was about a politician in a state known for its bipartisan political corruption.  The reality that 20% – one in five – of the last century’s governor’s have been indicted or convicted of felonies in Illinois is a damaging statistic to all Illinois politicians.  Damaging is one thing, but suspicion on a federal level and a House Ethics Committee investigation for ties to imprisoned former Illinois governor Rod Blagojevich is quite another.  This federal investigation provides a significant foothold of suspicion in Rep. Jackson’s June disappearance and yesterdays news story confirming his diagnosis and treatment for major depression (one-half of the mental illness, bipolar).

The vitriol posted in comment sections of Chicago area TV stations extolling Rep. Jackson’s disclosure of mental illness and gastric by-pass as a creative and sympathetic smoke screen hoping to derail the federal investigation or, at the very least, to mitigate its voraciousness.  The assertion? That Rep. Jackson was in the middle of a hypo-manic (the other half of the mental illness, bipolar) episode which characteristically emboldens the patient to behave dangerously, generate grandiose plans well beyond his normal specter of life, and indulges in dangerously poor judgement particularly in highly sensitive or personal areas of the patients life.  If Rep. Jackson never mentioned (prior to the Blagojevich sting) that he’d like to advance his political career by winning a senate seat and then suddenly (and privately) begins the high-stakes game of buying (rather than campaigning for) a senate seat, Rep. Jackson could defend his uncharacteristic behavior as that of his manic-self (though at the time he was unaware of his mental illness), and that if his bipolar diagnosis was being properly treated (and he was compliant) he would’ve steered clear of any illegal activities.

Which is, by the way, a creative and sympathetic defense.  But our legal system does not recognize bipolar disorder as insanity, and therefore cannot be used as a defense in legal proceedings.  It could pluck on the heart strings of those on the House Ethics Committee, but any preferential treatment Rep. Jackson hopes his bipolar disorder might garner will be sanctimonious.  However, if the Committee (and subsequently Federal Prosecutors) sense blood in the water, Rep. Jackson’s recent disclosure of personal and private information will be sympathetically and respectfully noted.  And then the hounds will be unleashed and will, eventually, tree the red fox.

But what I find the most deplorable is the velocity and distribution of judgement by every-day citizens whose faith in politicians has been crushed by an unending parade of scandal, corruption, and greed.  Jesse Jackson Jr.’s job is a congressman.  Jesse Jackson Jr. also happens to be human, a husband, a brother, a son, a friend, and now part of my bipolar II world. 

It is shameful that the suspicious and the quick-to-judge deny their empathy to the mortal and vulnerable  Jesse Jackson Jr. who is suffering horribly, whose life is teetering on pharmaceutical roulette, who goes to sleep dreadfully depressed and wakes to the loathsome, disastrous, and painful reality that he must learn to live with bipolar disorder, not suffer from it.  To those casting stones, humanity and empathy aren’t yours to keep; they are given.  I pray that one day you won’t stare into the cold eyes of a stranger wholly disinterested in your immediate suffering because of a far-off suspicion of guilt.

An Open Letter to U.S. Representative Jesse Jackson Jr.’s Mayo Clinic Physicians

Dear Dr. So-and-So, et. al.:

I read with tremendous interest and a degree of de ja’ vu the front-page story written by Ms. Michael Sneed in the Sunday, August 5, 2012 Chicago Sun-Times which reported that U.S. Representative Jesse Jackson Jr. recently collapsed and had become completely debilitated by depression.  Upon reading the story, I experienced a staggering degree of recognition, for I too, have (and continue to do so) hit the same kind of wall as Representative Jesse Jackson Jr.: A crippling mental illness diagnosis, specifically major depression (changed later to Bipolar II) following gastric by-pass surgery.

The story reported that Ald. Sandi Jackson (wife of Representative Jesse Jackson Jr.) doesn’t know if her husband’s depression is connected to his weight-loss surgery.  As a person who finds himself in a very similar situation the development of major depression after elective gastric by-pass surgery) I would like to suggest that determining the cause of this on-set of depression is irrelevant and nearly impossible to determine.   Based on the past four years of failed orally administered pharmaceutical treatment attempts, I strongly suggest that you titrate the dosing levels of psychotropic therapies dramatically (50%-75% higher) or increase the potency of the psychotropic therapies to compensate for the substantial degree of malabsorption (the basic tenet of Duodenal Switch Surgery) caused by the significant reduction in stomach volume (up to 70%) and the dissection and rerouting of a large percentage of the small intestine (which is largely responsible for caloric absorption).  If the goal of the Duodenal Switch surgery is to limit volume and reduce absorption of food ingested orally, then common sense suggests that anything ingested orally will greatly lose its effectiveness (especially if the drug’s efficacy during clinical trials was based on subjects that did not undergo weight-loss surgery).  Except now we want the body to absorb what it’s ingesting!

I endured two needless years of trial and error attempting to discover pharmaceutical regimen which would lift me from depression and put a lid on my mania.  My psychopharmacologist knew I’d undergone gastric by-pass surgery a decade earlier yet refused to consider malabsorption as the cause of the ineffectiveness of every single prescription.  Frustrated by my psychiatric team’s myopia, I returned to the care of my internist; he was the first doctor to consider that my body’s ability to absorb oral treatments had been reduced by as much as 75%.  If an increase in dosage is impossible, then a different delivery system (IV, inhalation, transdermal patch, suppository) must be manufactured.   Please don’t waste Representative Jesse Jackson Jr.’s time prescribing the usual litany of drugs at their recommended doses: It’s akin to trying to stop a charging elephant with a water pistol.

Morbidly obese patients who were diagnosed as depressed and were being treated successfully through oral medications prior to gastric by-pass surgery discovered that post surgery their depression worsened and their pre-surgery oral medication treatment failed to reproduce the expected degree of pre-surgery success and relief.   Your patient is in crisis; your patient is experiencing a major depressive episode; your patient’s natural ability to absorb what he ingests has been compromised to the degree of ineffectiveness; your patient needs an extraordinary, preposterous, wholly unimaginable antidote, not a boilerplate solution. 

I salute the Jackson family for supporting Representative Jesse Jackson Jr. through this difficult period and wish them all God’s speed.